# Utility of Intraoperative Intrinsic Near-Infrared Imaging for Primary Hyperparathyroidism in Multiple Endocrine Neoplasia Type 1

## TL;DR

This case report shows how near-infrared imaging helped identify parathyroid glands during surgery for a patient with a genetic disorder called MEN1.

## Contribution

The study highlights the potential of intraoperative intrinsic near-infrared imaging for identifying parathyroid hyperplasia in MEN1 patients.

## Key findings

- Intraoperative intrinsic near-infrared imaging facilitated detection of all parathyroid hyperplasia in a MEN1 patient.
- The patient had successful surgery followed by hypoparathyroidism requiring calcium and vitamin D supplementation.
- The technique may improve outcomes by ensuring complete removal of diseased parathyroid glands in MEN1.

## Abstract

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder caused by mutations in the tumor suppressor gene MEN1 and is characterized by parathyroid, pancreatic islet, and anterior pituitary tumors. Primary hyperparathyroidism is the most characteristic finding in MEN1, and intraoperative identification and accurate removal of the diseased parathyroid glands are vital since incomplete excision results in recurrence. This case report describes a 59-year-old woman who had pancreatic islet cell tumors and pituitary tumors and underwent selective transsphenoidal adenomectomy. Based on her medical history and examination, the diagnosis of primary hyperparathyroidism in MEN1 was made, and she underwent total parathyroidectomy with autotransplantation with SPY-Elite®️ Fluorescence Imaging (Stryker Corp., Kalamazoo, MI). Intraoperative identification of the parathyroid glands using autofluorescence with real-time intrinsic near-infrared (NIR) imaging made it easier to detect all of the parathyroid hyperplasia. After the surgery, she had hypoparathyroidism and continued with her oral calcium and vitamin D supplementation to maintain normal calcium levels during follow-up. Herein, we would like to advocate that the use of parathyroid gland autofluorescence with real-time intrinsic NIR imaging may be useful for identifying parathyroid tumors in patients with primary hyperparathyroidism in MEN1.